“You think you have mastered it, but just as you get well underway in following, it turns a back –somersault and there you are. It slaps you in the face, knocks you down, and tramples upon you. It is like a bad dream.”
Just as it was in 1892, when Charlotte Perkins Gilman wrote her inspired-by-actual-events short Gothic story, “The Yellow Wallpaper,” so does modern healthcare refuse to acknowledge the real lives of women today. In the story, the hideous, choking pattern of the yellow wallpaper is an analogy for patriarchy.
“The front pattern does move—and no wonder! The woman behind shakes it! Sometimes I think there are a great many women behind, and sometimes only one…in the very bright spots she keeps still, and in the very shady spots she just takes hold of the bars and shakes them hard.
And she is all the time trying to climb through. But nobody could climb through that pattern—it strangles so; I think that is why it has so many heads. They get through, and the pattern strangles them off and turns them upside down, and makes their eyes white! If those heads were covered or taken off it would not be half so bad.”
Hospital ER visits are often gynecologically-related for women of childbearing age, yet most women anecdotally report being sent home for “stomach aches,” or “UTIs” (urinary tract infections), without ever having seen an OB/GYN or given an ultrasound. Many times the issue is terribly serious: ovarian cysts rupturing, painful fibroids, or endometriosis, yet she is sent home, only to require surgery mere hours or days later.
Chronic pain like fibromyalgia, neuorpathy (nerve pain), migraines, sickle cell anemia, back injuries, bad knees, and more are given little credence when reported by women. Rather, it is assumed ladies are hypochondriacs, melodramatically obsessing over every tiny thing. Batteries of standard tests are run, according to rule, that appear to show nothing, and the lady is sent home with antidepressants. She must be tired. It is all in her head.
“He says…I must use my will and self-control and not let any silly fancies run away me.”
“You see he does not believe I am sick!”
From abortion to birth control, to childbirth and everything in between, everyone wants to tell women exactly how to live, what to put into their bodies, what to have taken out, which surgeries to have done, which medications to use, and which to avoid.
Childbirth in America now involves being a number on the table, forced to follow painful and frightening “protocols” without full information or recourse. Once the baby is born, mom is sent home in 2–3 days to try and figure out this whole “baby care” (and self-care) thing by herself within 6 weeks, since dear husband (if he exists) must fly back to work.
Through silencing tactics like demeaning, patronizing, ignoring, rebuking, and gaslighting, women are not allowed bodily autonomy; politicians, husbands, religious leaders, and doctors all get to make the decisions for her, instead. “Can you not trust me as a physician when I tell you so?”
“I tried to have a real earnest reasonable talk with him the other day, and tell him how I wish he would let me go and make a visit to Cousin Henry and Julia. But he said I wasn’t able to go, nor stand it after I got there, and I did not make out a very good case for myself, for I was crying before I had finished.”
“But now let’s improve the shining hours by going to sleep, and talk about it in the morning!”
“He sat up straight and looked at me with such a stern, reproachful look that I could not say another word.”
The “husband and physician of good standing,” in the story calls his wife patronizingly, “little girl,” “a goose,” “imaginative,” and “foolish,” throughout. The good doctor constantly contradicts his wife’s assessments about her own body, including weight gain, appetite, and happiness- “Really dear, you are better!”-till, by the end, she insanely repeats those phrases herself:
“Life is very much more exciting now than it used to be. You see I have something more to expect, to look forward to, to watch. I really do eat better, and am more quiet than I was…I’m feeling ever so much better! I don’t sleep much at night…but I sleep a good deal in the daytime” (my emphasis).
Neglected, oppressed, and repressed, mental health issues like depression and anxiety take over.
“At night in any kind of light, in twilight, candle light, lamplight, and worst of all by moonlight, it becomes bars! The outside pattern I mean, and the behind it is as plain as can be. By daylight she is subdued, quiet. I fancy it is the pattern that keeps her so still.”
“I am getting angry enough to do something desperate. To jump out of the window would be admirable exercise, but the bars are too strong even to try. Besides I wouldn’t do it. Of course not. I know well enough that a step like that is improper and might be misconstrued.”
“I suppose I shall have to get back behind the pattern when it comes night, and that is hard! It is so pleasant to be out in the great room and creep around as I please!”
On top of all this are the social expectations: host parties, drink more/drink less, cook from scratch, raise your kids alone, volunteer in schools, have a garden, nurse babies until their five, care for aging parents, clean the house, read a book, take a walk, date your husband, be his “helpmeet”, hang with friends, take your pills, be a lifelong learner, be your own advocate in all things, have good credit, have a savings account, keep at least a part time job, go to church, lead a Bible study, don’t forget to travel because YOLO, and make sure to take time for yourself.
It’s enough to drive a gal…hysterical.
“‘For God’s sake, what are you doing!’ I kept on creeping just the same, but I looked at him over my shoulder.
‘I’ve got out at last, said I, in spite of you and Jane. And I’ve pulled off most of the paper, so you can’t put me back!’
Now why should that man have fainted? But he did, and right across my path by the wall, so that I had to creep over him ever time!”
Ah, but, “Bless her little heart! She shall be as sick as she pleases!
Legal disclaimer: Nothing in this post is meant to be construed as medical advice. I am not a physician or pharmacist. Discuss any medications, changes, or questions you might have with your medical provider. Do not suddenly stop any medication unless under the direct guidance of a medical provider.
Today was a weird day. What began with some light historic-ecclesiastical reading and plans to write a piece about a specific trend in feminism in antique literature, turned instead into a Twitter brawl in which I repeatedly questioned doctors and pharmacists on a certain status quo, and received 5th-grade-style memes of Homer Simpson in response. What was the cause? Buprenorphine.
More popularly known as Suboxone or Subutex, buprenorphine (“bupe” for short) has been touted in recent years as “the” drug of choice to treat opioid dependence disorders (formerly known plainly as “addiction,” for politically-incorrect and insensitive jerks like me, or so I was told).
Although my concerns about the safety and efficacy of buprenorphine became quickly misinterpreted as a war on drug addicts (or whatever the PC term is now), I ended up spending the day reading through study after study (see below for a list), but was hopelessly ganged up on by dozens of angry and less-than compassionate “professionals” who took the time to point out I must know nothing about the subject because I also “make jewelry.”
They insisted I could not read scientific or medical literature although such things are written in English and I am blessed to have access to ‘foreign’ objects like the internet and dictionaries to look up any unfamiliar terms, and in short, I had it all wrong, and my misinformation would inevitably lead to the untimely end of numerous, unnamed individuals. I just needed “to trust my doctors,” insisted one.
They had already read all the studies and charts I supplied, which is why they needn’t bother to look at the ones I provided and actually answer my questions. I hadn’t been privy to that much gas-lighting since the most recent family holiday.
I guess I touched a nerve.
What is Buprenorphine?
Buprenorphine is most commonly used in the US to treat opioid addiction. The idea is to transition people off heroin (and dirty needles, and other unhealthy practices associated with street drug addiction) and/or illicit painkillers. In much, much smaller doses (micrograms vs. milligrams), it is used to treat severe pain. Bupe is an opioid, and can cause addiction in and of itself.
Is Buprenorphine Safe?
This is the question that most concerns me, and I have legitimate reasons to wonder:
Although more people have access to bupe than ever before, OD rates are still rapidly climbing. Dr. Andrew Kolodny insists this is because “more people need more access to bupenorphine,” but haven’t we seen this doubling down of ineffectual policies before? Yes, except 5 years ago, the trend began with the false narrative that irresponsible doctors were getting people hooked on opioids. And who started that claim? Oh, yeah, that Dr. Kolodny guy.
My interview with a local substance abuse counselor from 5 years ago, indicated bupe was neither as safe nor as effective as touted. She told me then “substance abuse counselors hate it.”
There is a ton of money to be made by doctors who prescribe it (average $300 for first appointments, $150 or more for subsequent/monthly appointments, and whatever can be earned in lab and pharmaceutical kickbacks).
Federal guidelines were recently widely expanded to allow those doctors to be able to treat hundreds of patients at one time, instead of the strictly limited 30 patients from 12+ years ago (the strict limit was put in place to prevent doctors from essentially dealing the drugs to patients.
Now that it has been eased, a number of questionable practices have been increasing). A push by none other than PROP board members, via an article in the New England Journal of Medicine, asserts than everyone from nurse practitioners to OB/GYNs can and should be able to dispense buprenorphine, not just addiction specialists.
Bupe, in the form of Suboxone, costs an average of $151-518 for just 30 days of sublingual filmstrips for the uninsured, depending on dosage, and about $180-720 for 30 days of sublingual tablets, depending on dosage, up to 3x/day, although an original study of the drug, paid for in part by Reckitt-Benckiser, show the drug can last up to 3 days before needing a new dose. This was, in fact, a huge selling point of bupe, that people would not need to come daily to Suboxone clinics for the medication.
Patients on bupe can successfully go for 2-3 days on just one dose, reducing the need for daily clinic visits, and/or “reducing the need for take-home medications [which] decreases the possibility of illicit diversion and abuse of opioid dependence pharmacotherapies (Section 6)”
No Such Thing as Chronic Pain?
Contrary to PROP’s claim they do not want to ban opioids (of course they don’t, buprenorphrine is an opioid) or that they want to stop “drug companies” from promoting long-term opioids for chronic, non-cancer pain, Dr. Kolodny, founder and director of PROP, frequently promotes his ideas that essentially, there is no such thing as chronic pain, just opioid addiction.
That being the case, both birds can be killed with one stone groups can be helped via long-term maintenance with the opioid buprenorphine (made by a “drug company”).
There is an enormous body of evidence dating back literally millennia that points to the existence of chronic pain as a real and devastating illness if left untreated.
Copies of medical texts from Ancient Egypt and Greece to modern times describe hundreds at least, of debilitatingly painful conditions with no cure from back injuries to rheumatoid arthritis and damaged nerves, that impact the lives of an estimated 50 million chronic pain patients in the United States alone.
It is, at minimum, grossly irresponsible to claim these people and their well-documented diseases and the expertise of thousands of doctors don’t exist!
There is a form of bupe called the “Butrans patch,” made for chronic pain (the chronic pain that “doesn’t exist”). Many insurance companies are forcing patients and/or their doctors to try it or the fentanyl patch, although there are also extended-release (ER) pill formulas for Vicodin/norco at far lesser dosages that suffice most chronic pain patients just fine. Ironically, many of these companies have new “addiction reduction” policies that refuse to take chronic pain patients and their medical histories into account.
According to Drugs.com, the Butrans patch for chronic pain is known to actually cause pain and severe illness, withdrawal syndrome, and a host of psychological effects associated with drug abuse including anxiety and depression, agitation, hostility, and paranoia. It is not safe around children, pets, pregnant or nursing mothers, and must be dispensed in micrograms not milligrams like most pain medications.
That Old-Time Naloxone is Good Enough for Me
In an odd twist, Dr. Kolodny and his group, PROP, also push for buprenorphine to replace other long-acting, lower-strength opioid medications, insisting the abuse potential is much lower because of the Naloxone (Narcan) element in Suboxone.
However, “The Clinical Pharmacology of Buprenorphine: Extrapolating from the Laboratory to the Clinic,” by Sharon L. Walsh and Thomas Eissenberg, received on Dec. 19, 2002, and published by Elsevier and Drug and Alcohol Dependence on Feb. 4, 2003, and funded in part by Reckitt-Benckiser, the very makers of Suboxone, Subutex, and other very popular forms of buprenorphine, to introduce buprenorphine to clinicians, describing its safety and efficacy findings and how it appears to work, reveals:
“The doses of naloxone that precipitated withdrawal [in patients given 8mg of sublingual and 3 and 10mg doses of BPN/day]…were approx. 10 times greater than those that precipitated withdrawal in patients maintained with 30mg oral methadone” (Section 3.2.3).
Most patients are maintained on far higher doses, and the study’s authors also found other studies reported no withdrawal effects in patients given 8mg/day of bupe and challenged with 4mg of naloxone. The amount of naloxone in 8mg of Suboxone preparations is only 2mg.
The One “Good” Opioid in the Epidemic?
Current stats show the increasing rates of bupe abuse, and the original studies of bupe emphasize it, “does posses abuse potential.” Furthermore, the study describes bupe as producing “paradoxical” effects, “the same dose of buprenorphine can produce no detectable effects or it can produce prototypic opioid agonist effects and intoxication” (Section 3.2, emphasis added by blog author).
“Buprenorphine is not being monitored systematically enough to gauge the full scope of its misuse, some experts say. The Centers for Disease Control and Prevention does not track buprenorphine deaths, most medical examiners do not routinely test for it, and neither do most emergency rooms, prisons, jails and drug courts (emphasis added).
“I’ve been studying the emergence of potential drug problems in this country for over 30 years,” said Eric Wish, the director of the Center for Substance Abuse Research at the University of Maryland. “This is the first drug that nobody seems to want to know about as a potential problem.” –Source
Why Aren’t People Getting Clean with Bupe?
The study’s authors’ appeared to assume that patients on bupe could and would be easily transitioned (weaned) off with minimal withdrawal side effects. A relatively fast period of only 5 days claimed patients went from 8mg to 1mg with no withdrawal signs observed or symptoms reported (Section 3.2.3), but more and more patients are being maintained on moderate doses of 8-20mg of bupe indefinitely.
The study even states that patients on bupe can successfully go for 2-3 days on just one dose, reducing the need for daily clinic visits, and/or “reducing the need for take-home medications decreases the possibility of illicit diversion and abuse of opioid dependence pharmacotherapies” (Section 6, emphasis added by Rambling Soapbox).
Buprenorphine is an unusual drug by all accounts, which has been the cause of much misinformation, however it works just like any other opioid. According to multiple studies, it causes the exact same effects as other opioids, including intoxication, sedation, euphoria, respiratory depression, constipation, behavioral impairment, and urinary retention.
What sets bupe apart, is how it binds with opiate receptors in the brain. Many people think it blocks the effects of other opioids, but bupe binds faster and longer than more traditional opioids, including heroin and OxyContin.
According to Emergency Medical News, bupe, methadone, fentanyl, and often even oxycodone CANNOT BE DETECTED IN URINARY ANALYSES, and while chronic pain patients have been legally limited, force-tapered, dropped from practices, abused, forced to endure routine UAs although physically disabled, and stigmatized to taking 90MME (morphine milligram equivalence) or less (or none) for their safety, addicts are recommended to take many times that amount!
99 Problems, and the Studies are 1, 2, 3…
Concerning trends arise upon review of certain buprenorphine-related clinical studies, including the Walsh and Eissenberg study. Extremely small numbers of subjects were tested, for example, 7, 5, 10, 8, and 8, throughout the 1990s (Walsh and Eissenberg, Section 3.2.1). Other “larger” studies had only 99 subjects.
More recent studies include odd comparisons of numbers that effectually obscure real conclusions like this one from Spain, which looked at 19 other studies published between 1974-2016 (an odd range with no explanation given) from several high-income countries, more than 70% of whom were males with mean ages of 23-39.6, and featuring around 100K patients in 13 different groups on methadone for 1-13 years, but only around 15K patients in 3 groups on buprenorphine for just 1-4 years, to show how patients remained alive while on MAT treatment.
The doctors I “spoke” with on Twitter claimed that patients were more likely to die once off bupe, citing studies in European countries like this one, but a quick review reveals the key seemed to be patients who were both on a medication-assisted treatment (MAT) like bupe AND in a supervised, residential treatment center. Much like the ones the substance abuse counselor I interviewed 5 years ago lamented the loss of…
This is Not Treatment
Unlike the assumptions in the original study that patients on bupe will either receive treatment in-office, or be prescribed a single dose to last up to 3 days, there has been a strong push to allow addicts to be prescribed bupe for take-home use, such as this message, brought to you by the curious National Alliance of Advocates for Buprenorphine Treatment.
In other words, people with addiction issues to narcotics are being given powerful narcotic prescriptions a month at a time to take home,a scenario the study’s authors never imagined or recommended!
Let me restate: people with self-control issues around opioids are sent home with bottles of opioids and expected not to overdose? No wonder the relapse rate is so high. That is devastating.
Stats prove that drug abusers often mix different classes of drugs (known as a “cocktail) resulting in overdoses, so why should buprenorphine be pushed as the only cure-all when, not only are there two more established addiction treatment drugs, namely Methadone and Naltroxene (Naltroxone, in particular, is a non-opioid that also works to reduce cravings for alcoholism), but Narcan and bupe will not work to reduce cravings for the other types of drugs many users abuse, including antidepressants, anti-anxiety meds, stimulants, and hallucinogenics. This might be why:
“Buprenorphine is now more popular than cocaine, ecstasy, and heroin in some European countries. It is easy to obtain, currently quite fashionable, popular with opioid aficionados, and apparently associated with a quite pleasurable high when injected or snorted.
I would not be surprised to see more BPN issues in the ED, given the rise in its popularity, its increasing availability, and its perceived wide margin of safety. One might be confused by an opioid toxidrome with a negative drug screen unless the drug has been identified by history.” –Source
Apologies to my readers for being so silent these past few weeks. I have been fighting, fighting, fighting and getting my ducks in a row for the future. Calling customer service, et al has (hopefully, “had”) become my full-time job while trying to get finances, kids’ busing, and my health back in order. Shew!
I have so many new ideas and research projects to share, and I hope to do so in the coming weeks, but I still have a few more loose ends to tie up first.
Last night I voted via absentee ballot, as I have done for the past 3 years since my disability (which impairs my strength, stamina, and mobility) began. I was pleased to see that every leader running for office mentioned their deep and sincere concerns regarding the opioid crisis, which has hit Ohio in general hard, and my city of Dayton, particularly hard.
In my suburban neighborhood, over the past 5 years, I have personally witnessed people in terrifyingly angry states of withdrawal and people trying to get into my backyard fence while my daughter and I sat outside, unaware, until a neighbor showed us the video hours later. I have seen 2 deaths (one, a family member of my husband), heard raucous parties at all hours next door, had a car broken into, and coordinated with local police on numerous occasions. I have seen children left without parents, toddlers being dragged through the foster care system, and parents who failed rehab again and again.
At the same time, I have also witnessed neighbors with legitimate, painful, chronic disabilities, desperately asking for pain meds, terrified because they had no money for the emergency room, no money for the constant doctor appointments required now of chronic pain patients, and no doctor willing to treat them anyway. They had to work, but how could they work when doubled over in agonizing pain? They had to work, but how could they work and go to the long, frequent, and burdensome appointments needed to receive legitimate medication?
Ohio leaders have not taken the needs of chronic pain patients in mind when going after the opioid crisis. Indeed, current laws have squeezed such people so much, many feel they are either doomed to die by suicide or stress from the unrelenting pain, or be forced to obtain illegal substances (currently so much cheaper and easier to get, and increasingly without penalty-unlike the near-impossible hoops chronic pain patients have been forced to jump through) so they might survive. Ohio laws are MAKING MORE CRIMINALS where there were none.
Despite popular theories from addiction psychiatrists with no experience treating chronic pain patients; despite propaganda backed by anesthesiologists (who make up the majority of pain clinic doctors and have a great deal to gain, financially), statistically, most chronic pain patients are not opioid addicts. They desire to get back to living, while opioid addicts are trying to escape life. Both populations need help, but in different ways. Most chronic pain patients are elderly and veterans. Most chronic pain patients have already tried multiple, non-opioid approaches to manage their pain. Most chronic pain patients are not seeking a high, but simply control of their real, physical pain to get back to having quality of life. Consequently, most doctors are also responsible citizens and professionals, but their practices have been upended and in some cases unjustly destroyed because of laws that assume guilt first.
I know you want what is best for all Ohioans, so I challenge you to find innovative ways to help stem the opioid crisis, by talking to practitioners from multiple backgrounds; by talking to chronic pain patients; by talking to police officers; by talking to substance abuse counselors; by talking to addiction specialists; by talking to those with substance abuse problems. So far, we have seen the devastating effects of one-size-fits-all approaches on all of the aforementioned communities. While pain is rarely treated anymore, opioid overdose deaths continue to rise to staggering proportions. We need to regroup and come up with a better plan that involves everyone. Together, we can make Ohio great again.